Submission 362 - Heads of Departments and Schools of ...
Submission to the Productivity Commission Review: The Social and Economic Benefits of Improving Mental Health – Heads of Departments and Schools of Psychology Association (HODSPA)Professor S.Kent, Chair HODSPA, La Trobe UniversityProfessor R. Meuter, Deputy Chair HODSPA, Queensland University of TechnologyProfessor J.A. Pooley, Secretary HODSPA, Edith Cowan UniversityAssociate Professor K. Burke, Treasurer HODSPA, Central Queensland UniversityEmeritus Professor N. W. Bond, Executive Officer HODSPA, Western Sydney University015875000“Psychologists are experts in human behaviour, having studied the brain, memory, learning, human development and the processes determining how people think, feel, behave and react. Psychologists apply their expertise using reliable and scientifically supported methods.” Australian Psychological Society ()“Psychology is the scientific study of people, the mind and behaviour.”?British Psychological Society ()“APA is the leading scientific and professional organization representing psychology in the United States. Our mission is to advance the creation, communication and application of psychological knowledge to benefit society and improve people's lives.” ?American Psychological Association ()“APS is the premiere international organization solely dedicated to the advancement of psychological science. APS works diligently to?increase support for psychological research?and to promote the use of science-based psychology in the?development of public policy.” Association of Psychological Science ()These organizations represent both academic and professional psychologists. They share in common the belief that Psychology is a science and that the applications of Psychology should be based upon scientific evidence.It is interesting to note that five scientists, who called themselves Psychologists, have won the Nobel prize, namely Daniel Kahneman, Ivan Pavlov, Herbert Simon, Roger Sperry, and George von Bekesy. Note that their fields are cognition, learning, and neuroscience. None of them were ‘professional’. This is not to deny the importance of professional Psychology, which is the focus here, but it does counter the notion that Psychology is simply another ‘helping’ profession. ()Executive summaryPsychology is both a discipline and a profession. The majority of students in Australia take an undergraduate degree in Psychology. A small percentage go on to take a professional postgraduate degree or a postgraduate research degree. When they have completed Honours if they wish to pursue a professional pathway, a student can enter either a 1-year ‘generalist’ Masters or a 2-year ‘specialist’ Masters. Completion of the 1-year Masters is followed by a 1-year internship after which the graduate can apply for registration as a ‘generalist’ psychologist. Completion of the 2-year Masters and a subsequent 2-year Registrar program allows a student to be registered with an appropriate Area of Practice Endorsement (AoPE), e.g., as a clinical psychologist. It is assumed that because training in professional psychology takes 5 or 6 years at a Higher Education Provider, it is expensive. We present data showing that it costs the Commonwealth more to train any other allied health professional than a ‘specialist’ psychologist and significantly more than a ‘generalist’ psychologist. Clearly, increasing the number of trained psychologists is both a cheaper and higher quality approach to improving mental health across Australia than training any other allied health professional. The members of the Heads of Department and Schools of Psychology Association (HODSPA) have identified the need to recruit more Indigenous students at all levels in psychology, and the need to improve access to psychological services in rural and remote communities as challenges that HODSPA needs to focus on.HistoryIn Australia the first program in Psychology was offered by Sydney University over 100 years ago. The early programs in Psychology grew out of Philosophy and provide the backdrop for the bicameral nature of the discipline, with one foot in Arts/Social Sciences and the other in Science. However, following on from the United States and the United Kingdom, Psychology in Australia is regarded as a scientific discipline and its professional practitioners are trained to be scientist/practitioners. Undergraduate programs in Psychology are typically 3 or 4 years in duration. Until the early 1990’s, most programs were 3 years long and were embedded within the generalist Bachelor of Arts and Bachelor of Science programs. Graduates could then enter an Honours program of one year, leading to a BA (Hons) or a BSc (Hons). Competition for Honours places was and still is, fierce.In the 1990’s, a number of universities introduced variants on the Bachelor of Psychology (Honours) program. These are typically four years in duration and students may be guaranteed a place in Honours if they maintain a certain standard of academic performance. Note that the 3-year undergraduate degree allows students to progress their studies in other areas, e.g., counselling. It is the 4th year that is required for further professional and/or research training specifically in the scientific discipline of Psychology.Upon completion of their undergraduate program, students have acquired a set of Graduate Attributes (or Competencies under the new APAC Standards), which include both numeracy and literacy, in addition to their subject knowledge. They design, conduct, analyse, and write-up research on a variety of topics in neuroscience through to social psychology. However, this is not professional training and they are not Psychologists. It is not until they have completed their Honours program that they can seek provisional registration, a requirement if they enter a Masters/Doctoral program in one of the areas of professional Psychology or enter into a set of supervised placements. This latter pathway is often referred to as the supervised practice, or 4+2 pathway. Psychology is a popular area of study, both at university and when offered at secondary level. Recently, Psychology has become the 4th most popular ‘A’ level in England. The top three are all compulsory units! The same is true in Australia. Psychology is popular in those States where it is included in the Higher School Certificate or equivalent, namely Queensland, South Australia, and Victoria. Interestingly, the introduction of Psychology into the secondary school curriculum has had little impact on the numbers enrolled at tertiary level.The load in Psychology at various levelsFigure 1 shows the load in Equivalent Full-Time Student Load (EFTSL) at the various degree levels in Psychology for the years 2008 and 2017. Load in the Pass degree program (3 year named Bachelor degree in Psychology) has grown 78.1% from 2008 to 2017. The growth in load over the same period for the Honours degree program is now outstripping the growth in the Pass degree at 249.8%. Load in both professional postgraduate and professional research programs has also grown (61.1% and 21.0% respectively) but at a slower rate than for the undergraduate programs. The growth in the professional programs has been bolstered by the introduction of a number of 5+1 programs (see below), a pathway that is replacing the soon to-be-phased out 4+2 pathway to ‘generalist’ professional registration. Numbers in ‘specialist’ 2-year Masters programs have grown more slowly. Note that the small increase in professional numbers over the years lays the lie to the notion that the members of HODSPA are flooding the market with professional psychologists. It is true that most institutions would like more students in their professional programs given the demand for places, however there are various constraints on numbers in such programs, which we will discuss later.There has been some growth in research training programs. However, given that the Commonwealth Government controls the numbers entering these programs across all disciplines, it has been quite small. Figure 1: Load in psychology for various degree levels for the years 2008 and 2017.Most people incorrectly assume that psychology is about training professional psychologists only. As Figure 1 shows, the load associated with training professional psychologists is a relatively small part of the overall load in Psychology. Indeed, because of the growth in Pass and Honours degree load, it has fallen from 11% in 2008 to 8% in PARISONS WITH THE SECTOROf course, students pursue programs other than Psychology. However, few programs have grown to the same extent. Thus, total sector load in 2008 was 1,066,095 EFTSL, consisting of 771,570 EFTSL domestic students and 294,525 EFTSL international students. This has grown to 1,513,383 EFTSL in 2017, or by 42.0%. Domestic load is now 1,081,821 EFTSL and international students load is 431,562 EFTSL. The former has grown by 40.2%, while the latter has grown by 46.5% or roughly proportional. The total load in Psychology has gone from 16,962 EFTSL in 2008 to 30,849 EFTSL in 2017, or 81.9%, a significantly higher rate of growth.The training of psychologistsHow are professional psychologists trained and how do the various programs fit together? Figure 2 sets out the different ways that people can become a professional psychologist and illustrates the relationships between the programs (see end of document.) The tertiary sector in Australia is noted for its innovation and its flexibility and Psychology is no exception. As noted previously, Psychology is both a discipline and a profession. Students of Psychology first complete an undergraduate program of 3 or 4 years. If they complete the latter (i.e., an Honours degree in psychology), they can apply for entry into a ‘generalist’ Master of Professional Psychology program, commonly referred to as the 5+1 program, or they can enter a ‘specialist’ Master’s program. Here they complete 2 years of training, following which they can complete a 2-year Registrar program to obtain an Area of Practice Endorsement (AoPE). There are currently nine such specialties as listed below. Clinical Psychology is by far the most popular and the most numerous in terms of programs. The latter may be due to the fact that clinical psychologists are paid at a higher rate under the Medicare Benefits Scheme (Better Access.)Clinical Clinical NeuropsychologyCommunityCounsellingEducation and DevelopmentForensicHealthOrganizationalSports and ExerciseIf a student wishes to pursue the research stream, they enter a doctoral program. Roughly as many students enter a research degree as enter a ‘specialist’ professional degree. Students can also combine ‘specialist’ professional training with a research doctorate. Currently, it takes 4 years to obtain an AoPE, such as Clinical Psychology, remembering that the first four years is not professional training and most students do not become professional psychologists. Importantly, the last two years are spent completing a Registrar program. This is paid employment and can be in a variety of settings. It is not funded by the Commonwealth Government. (Elsewhere, we have argued that the 2 years of the ‘specialist’ Masters and the 2 years of the Registrar program should be regarded as the equivalent of a professional doctorate, recognising that it is 4 years of postgraduate work.)‘Generalist’ training takes 1 year at an accredited institution. It is followed by a supervised placement, some of which are paid. Again, this final year is not funded by the Commonwealth Government.Departments and Schools of Psychology have always been flexible and innovative with respect to training. Figure 2 illustrates this; if a person has completed an undergraduate degree in another discipline, they can take a 1-year Graduate Diploma in the discipline of Psychology to complete the undergraduate component of psychological scientific grounding. They are then eligible to apply for entry into a 4th year psychology Honours program, and upon its successful completion, to apply for entry into either a ‘specialist’ Master’s or a ‘generalist’ program in Psychology, as shown.Recently, we have been discussing how those people who are registered as ‘generalist’ Psychologists might complete ‘specialist’ training in order to obtain an AoPE. The PsyBA has adopted a recommendation from HODSPA (consistent also with the revised APAC Standards), which argues that the 2-years of specialist training can be split into a ‘generalist’ year similar to the 5th year of the 5+1 and a ‘specialist’ year. Given that ‘generalist’ psychologists have completed the first year of the professional training, as shown in Figure 2, they now only have to complete the second ‘specialist’ year via a 1-year bridging program. They would then have to complete the Registrar program, although we believe there is a conversation to be had as to whether they should have to complete the full 2-year program.Some might argue that these pathways are all very well but how are people to do them when they have work and family commitments? There are many examples of online undergraduate programs in Psychology. Recently, Monash University in the east and Edith Cowan University in the west have both had an online Honours program accredited by APAC. Some 5+1 programs are also offered in intensive mode, e.g., at weekends and in distance mode. Some ‘specialist’ Master’s programs are also offered in distance mode.The Under-funding of undergraduate psychology Anyone entering an undergraduate program in Psychology can leave after three years with a degree and an impressive set of competencies that include skills in literacy, numeracy, and critical thinking. If they leave after their fourth (Honours) year, in addition to strong pre-professional skills, they add to that some of the best advanced research design and statistical training on offer at Australian Universities. Finally, if they leave after completing a further 2 years they emerge as professional Psychologists able to pursue an Area of Practice Endorsement. We must remember that Psychology at Higher Education Providers is not just about training professional Psychologists. Indeed, as illustrated in Figure 1, the vast majority of students leave with a Pass degree (71.5% in 2017). Just under 10% of the total number of students enrolled in Psychology programs in Australia in 2017 completed postgraduate training towards professional registration as a Psychologist. The UK funding model is much closer to Australia than the USA. Undergraduate psychology is categorised as a STEM discipline in the UK, but not in Australia. Unsurprisingly, institutions in the UK receive more money per student than do institutions in Australia. People will be aware that institutions receive a Commonwealth Government contribution and a Student contribution for each EFTSL. The levels of which are set by the Commonwealth Government and can be found at: The levels for most undergraduate psychology subjects, which is classified as ‘behavioural science’, are a Commonwealth contribution of $10,630 and a Student contribution of $6,566 respectively. This means that Australian institutions receive a combined total of $379,137,408 as a result of their undergraduate load in psychology, of which the Commonwealth Government component is $234,370,240. (In the various summaries to follow, overall funding is in red and the Commonwealth Government contribution is in green. See also Figure 3.)Current funding 22,048*$17,196 = $379,137,408, or 22,048*$10,630 = $234,370,240If undergraduate psychology were classified as ‘allied health’, the Commonwealth Government contribution would be $13,073 and the Student contribution would be $9,359. Institutions would receive $494,580,736, of which $288,233,504 would be Commonwealth Government funding. Funding if at the level of Allied Health22,048*$22,432 = $494,580,736, or 22,048*$13,073 = $288,233,504However, as noted above the UK classifies undergraduate Psychology as STEM, recognising the significant costs of running a laboratory-based discipline. STEM disciplines receive $18,586 per EFTSL from the Commonwealth Government and $9,359 as the Student contribution. If psychology was funded as a STEM discipline, institutions would receive $616,131,360, or nearly 2* as much as they do now. The Commonwealth Government contribution would be $409,784,128.Funding as a STEM discipline 22,048*$27,945 = $616,131,360, or 22,048*$18,568 = $409,784,128These comparisons are summarised in Figure 3, which illustrates that the basic component of training in Psychology, the undergraduate program, is seriously under-funded. Therefore, it is difficult to argue that training in Psychology is expensive compared to other disciplines.Figure 3: Student and Commonwealth contributions at various levels funding for undergraduate paring the costs of professional training in psychology with that of other allied health professionalsDespite the above, many people and organisations cling to the belief that training in psychology is costly, especially Federal and State Governments. Thus, it has been argued that a professional psychologist takes longer to train and is therefore more expensive than most other allied health professionals. After all, a professional psychologist takes at least 6 years to train, including the undergraduate component, whereas most of the other allied health professionals, e.g., audiologist, optometrist, podiatrist, or pharmacist, take 4 years to train. However, this confuses the length of time it takes to complete training with the actual cost of training. An allied health professional takes 4 years to train and their entire program is devoted to their professional training. Thus, we can multiply 4 years by $22,432, comprising of $13,073 of Commonwealth funding and $9,359 of Student contribution, to obtain the cost of training an allied health professional, which is $89,728, of which $52,292 is Commonwealth funding.Allied Health costs4*$22,432 = $89,728,4*$13,073 = $52,292However, as noted above, undergraduate psychology is typically embedded in an Arts or Science degree and the Australian Psychology Accreditation Council, the accrediting body, requires that only 40% of the undergraduate degree should be psychology. Hence, we can multiply 0.4 by $51,588 (3 years by $17,196), to obtain $20,635 to cover the cost of undergraduate training in psychology. The Honours year is all undergraduate psychology, so this adds $17,196 to the cost. Finally, for a ‘generalist’ psychologist doing a 5+1, they complete a 1-year Masters. To be fair, let us fund this at the level of ‘clinical psychology’, which is the highest level and Commonwealth funded at $13,073 and a Student contribution of $6,566, making $19,639. If we add $20,635+$17,196+$19,639 = $53,347, which is considerably less than it costs to train any other allied health professional! And remember that this includes both a Commonwealth component and a Student contribution component. The Commonwealth component is only $37,089. ‘Generalist’ Psychologist costs(0.4* $51,588) + $17,196 + $19,639 = $53,347, or $12,756 + $10,630 + $13,703 = $37,089Indeed, we can extend this logic to ‘specialist’ training, which involves a 2-year Masters. Again, let us fund this at the level of clinical psychology. We add $20,635+$17,196+$39,728 = $77,559, of which the Commonwealth component is $49,532. Thus, it costs the Commonwealth more to train any other allied health professional than a ‘specialist’ psychologist. ‘Specialist’ psychologist costs(0.4* $51,588) + $17,196 + $39,728 = $77,559, or $12,756 + $10,630 + $27,406 = $49,532These comparisons are illustrated in Figure 4, which shows quite clearly that it costs less to train a ‘specialist’ psychologist than any other allied health professional and much less to train a ‘generalist’ psychologist, whether we look at the Commonwealth contribution, the Student contribution, or their combination. Some argue that professional psychologists are too expensive and that it would be cheaper to employ other allied health professionals to improve mental health. Clearly, this argument is nonsense. Leaving aside the obvious arguments about the expertise of professional psychologists in being able to understand the issues involved in mental illness and its treatment, increasing the number of trained psychologists is a cheaper approach to improving mental health across Australia than training any other allied health professional. We rest our case.Figure 4: The Student and Commonwealth contributions to the funding of professional programs in allied health, ‘generalist’ psychology, and ‘specialist’ psychology.Length of training was always a furphy anyway. It is not as if we train one cohort for 6 years and then commence with another cohort. Professional psychologists are being graduated all the time. Indeed, Psychology is one of the few allied health professions that does not need to recruit overseas to cover a shortfall.International comparisons show that training in professional psychology in Australia is cheap compared to the UK and USA. Both the UK and USA require doctoral training to achieve ‘specialist’ status. Thus, it takes 7 years to complete professional training as a clinical psychologist in the UK and 8 years in the USA, followed by an internship. As set out above, it takes 6 years in Australia. Supporting mental health initiativesEnhancing the quality and increasing the number of professional psychologistsHODSPA, together with the APS and the PsyBA, agreed that the 4+2 route to professional training is no longer fit for purpose and that it should be replaced by the 5+1 program set out in Figure 2. This transition will take place over the next few years and it involves the development of sufficient 5+1 programs across multiple institutions to take on an additional 2,500-3000 Masters students. This is a significant undertaking but necessary to further improve the training of professionals who will take their place in the mental health workforce.At the same time, in collaboration with the APS and PsyBA, HODSPA has put forward a route whereby ‘generalist’ psychologists can obtain an ‘Area of Practice Endorsement’ via a bridging program, e.g., in clinical psychology.We saw in Figure 1 that the number of students in professional programs has not increased markedly over the years 2008 to 2017. Why is this the case? There is certainly significant demand. In a recent survey, we found that less than 10% of applicants receive an offer to the program and institution of their first choice. Of course, many are able to take up an offer from further down their list and do so. However, it is likely that the number of able and qualified students could be doubled. This has not happened for two reasons, expense and a lack of supervised placements.First, until recently, the accreditation requirements for ‘specialist’ programs were such that institutions were likely to lose money for every additional student that they admitted. Fortunately, we have a new set of Accreditation Guidelines and some of the constraints have been relaxed. Some remain, however, for example the required staff:student ratio, was previously set at 1:8. The new guidelines require a staff: student ratio of 1:15 for ‘generalist’ psychology programs and 1:10 for ‘specialist’ psychology programs. The latter means that institutions can recruit 20% more students for the same number of staff, hardly conducive to the growth that could be achieved given the demand from quality students.The problem of supervised placementsThe second constraint is the inability of institutions to find adequate supervised placements. The PsyBA is regularly updating the requirements placed upon supervisors and this means that many are either no longer able to meet the standard required or decide that they no longer wish to take on the onerous requirements to maintain supervisor status. For example, a change in the requirements in late 2018 saw the number of registered ‘specialist’ supervisors fall from 9,962 to 7,637. A second issue around placements is not unique to psychology. Some State Health Departments, e.g., Victoria, are requiring that institutions pay for supervised placements within the Health Department. These costs are significant and have led to the demise of a large number of professional doctorates in psychology, which required an Advanced Practicum. This was proving so expensive that many institutions closed their programs. Only four remain around Australia down from more than 20.The paradox is that State Health Departments are charging institutions that are Federally funded to train the next generation of people who will work in the State Health Departments! We have been discussing this issue with Universities Australia, but when this cost is levied against medicine, nursing, and the other allied health professions, it will become more and more significant, likely running into the hundreds of millions of dollars transferred from the Commonwealth Government to State Governments. Recruiting more Indigenous AustraliansHODSPA is mindful that Indigenous Australians are under-represented in psychology programs at all levels. For example, 1.3% of the undergraduate cohort is Indigenous compared to a population average of approximately 3%. Likewise, only 0.63% of the professional degree cohort and 0.51% of the research degree cohort are indigenous. There is evidence that the undergraduate cohort is growing. However, we have identified that Honours is the bottleneck preventing indigenous students moving through into professional training, in particular. As noted previously, competition to get into Honours is fierce and the cut-off for entry into psychology Honours is typically much higher than the rest of the university. Some institutions have decided to admit indigenous students where they meet the university criteria, even if they fall below the psychology cut-off. Others are sequestering places for indigenous students. Finally, some institutions are setting the level for entry into psychology Honours at the level of the rest of the university, which will make it easier and less tokenistic for indigenous students to gain a place in Honours.Most institutions have places and scholarships available for indigenous students at the professional level. However, as noted these can remain unfilled because of the issue around Honours.While we should not assume that an indigenous graduate will work within their community, we should at least give them this choice. Medicine has shown that it is possible and provides examples of strategies that other disciplines can follow in recruiting indigenous students.Accessing psychological services in rural and remote areasPsychology like other health disciplines has a problem providing services in rural and remote areas. One of the best ways to overcome this problem is to embed students in such areas via a supervised placement. Indeed, this is what the National Review of Accreditation Systems (NRAS) has recommended. The problem arises in obtaining supervised placements in areas where there is already a shortage of practicing professionals.For example, there are only 19 registered clinical psychology supervisors in the Northern Territory. Given that each student requires 3 placements during their 2-year Masters training, this is clearly problematic. And many of these clinical psychologists will be working in Darwin itself. Clearly, any change to the requirements for supervisors will have an impact on the numbers available. Regional universities can contribute to overcoming this problem, but they can be hamstrung by the lack of supervised placements in remote locations. The move to support telehealth would be useful in overcoming the lack of access to psychologists in rural and remote regions and some institutions, e.g., Macquarie University, are able to provide their students with a placement focused upon telehealth. Macquarie may be able to open up placements to other students in the Sydney basin. Providing practising professionals who have experience of and are competent in telehealth will be of great benefit. Telehealth is not for everyone and trained professionals will make the judgement about when it is appropriate. Importantly, if some clients are happy to work within the telehealth environment, this will reduce demand for face-to-face contact and make it easier for those who require this form of contact to better access it. In sum, the members of HODSPA are working to increase the number of professionally trained psychologists, while at the same time improving the quality of their training. We have identified the low numbers of Indigenous students taking psychology at all levels and the need to improve access for regional and remote clients as challenges that we need to focus on.Figure 2: Composition of the ‘specialist’ Masters programs and the ‘generalist’ Master of Professional Psychology program. The other parts of the figure show how someone who has completed a non-psychology undergraduate degree can complete the undergraduate Pass/Honours component in 2 years. Finally, the rightmost part of the figure show how ‘generalist’ psychologists can gain an Area of Practice Endorsement through completion of a bridging program and a Registrar program.ABThe 'specialist' The 'generalist' Changed your Converting Masters route5+1 routeMindB to APassPassCompletedPassPassother degreePassPassGrad DipHonoursHonoursHonoursPostgraduatePostgraduateEither A or BPostgraduatePlacementPostgraduateRegistrar programRegistrar program ................
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